Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs

Today, prosthetic joint infection (PJI) is still a relatively rare but devastating complication following total hip and/or knee arthroplasty. The treatment of PJI is difficult due to a number of...

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Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-212339 ◽

2017 ◽

Vol 77 (2) ◽

pp. 281-288 ◽

Cited By ~ 38

Author(s):

Rene Lindholm Cordtz ◽

Kristian Zobbe ◽

Pil Højgaard ◽

Lars Erik Kristensen ◽

Søren Overgaard ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Total Knee Arthroplasty ◽

Cohort Study ◽

Knee Arthroplasty ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Risk Of Death ◽

Prosthetic Joint ◽

Increased Risk ◽

Total Knee

ObjectivesTo investigate predictors of 10-year risk of revision and 1-year risk of prosthetic joint infection (PJI) and death following total hip/total knee arthroplasty (THA/TKA) in (1) patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (OA); and (2) patients with RA treated with biological disease-modifying antirheumatic drugs (bDMARD) within 90 days preceding surgery compared with non-treated.MethodsRegister-based cohort study using the Danish National Patient Register, the DANBIO rheumatology register (RA-specific confounders and treatment episodes) and the Danish Hip and Knee Arthroplasty Registers. Survival analyses were used to calculate confounder-adjusted sub-HRs (SHR) and HRs.ResultsIn total, 3913 patients with RA with THA/TKA were compared with 120 499 patients with OA. Patients with RA had decreased risk of revision (SHR 0.71 (0.57–0.89)), but increased risk of PJI (SHR=1.46 (1.13–1.88)) and death (HR=1.25 (1.01–1.55)). In DANBIO, 345 of 1946 patients with RA with THA/TKA had received bDMARD treatment within 90 days preceding surgery. bDMARD-treated patients did not have a statistically significant increased risk of revision (SHR=1.49 (0.65–3.40)), PJI (SHR=1.61 (0.70–3.69)) nor death (HR=0.75 (0.24–2.33)) compared with non-treated. Glucocorticoid exposure (HR=2.87 (1.12–7.34)) and increasing DAS28 (HR=1.49 (1.01–2.20)) were risk factors for mortality.ConclusionPatients with RA had a decreased 10-year risk of revision while the risk of death and PJI was increased compared with patients with OA following THA/TKA. bDMARD exposure was not associated with statistically significant increased risk of neither PJI nor death in this study. Glucocorticoid exposure and increased disease activity were associated with an increased risk of death.

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Prosthetic Joint Infection Risk Following Total Hip and Knee Arthroplasty in the Medicare Population

The Journal of Arthroplasty ◽

10.1016/j.arth.2008.11.018 ◽

2009 ◽

Vol 24 (2) ◽

pp. e4 ◽

Cited By ~ 1

Author(s):

Steven M. Kurtz ◽

Kevin Ong ◽

Edmund Lau ◽

Kevin J. Bozic ◽

Javad Parvizi ◽

...

Keyword(s):

Knee Arthroplasty ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Infection Risk ◽

Total Hip ◽

Medicare Population ◽

Prosthetic Joint ◽

Hip And Knee Arthroplasty

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Anti-rheumatic treatment and prosthetic joint infection: An observational study in 494 elective hip and knee arthroplasties.

10.21203/rs.2.18845/v1 ◽

2019 ◽

Author(s):

Ylva Borgas ◽

Anders Gülfe ◽

Mikael Kindt ◽

Anna Stefánsdóttir

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Surgical Site Infections ◽

Joint Disease ◽

Tnf Alpha ◽

First Year ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Prosthetic Joint ◽

Disease Modifying

Abstract Background Surgical site infections are more frequent among patients with rheumatic disease. To which extent this is related to immunosuppressive antirheumatic drugs is unclear, as is the value of discontinuing medication perioperatively.Objectives To assess the rate of surgical site infections after knee and hip-replacement in patients with inflammatory joint disease, with emphasis on periprosthetic joint infection, and to investigate the importance of medical treatment in this regard.Methods Data was collected from 494 primary elective hip- (51.4%) and knee arthroplasties along with demographic and medication data and primary outcome was surgical site infections during the first year after surgery.Results In 78% (n=385) of the cases the patient medicated with 1 to 3 disease-modifying antirheumatic drugs perioperatively. Thirty two per cent (n=157) of patients were on a TNF-alpha inhibitor perioperatively. The rate of surgical site infections was 3.8% (n=19) The rate of periprosthetic joint infection was 1.4% (n=7), all of which were knee arthroplasties. Only in 1 case of periprosthetic joint infection the patient medicated perioperatively with a TNF-alpha inhibitor.Conclusion Surgical site infections was not associated with ongoing medication with disease-modifying antirheumatic drugs. Due to low event rate this should be interpreted with caution. Routines at our centre, not stopping biologic disease-modifying antirheumatic drugs perioperatively, will be unchanged.

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